FREE CLAIM EVALUATION

  • I handle claims for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits, for adults and children, in the greater Lansing area and throughout the state of Michigan. I can help you file your initial application or help with your appeal if your application has been denied. If you cannot come to my office, I will come to you; house calls or hospital conferences may be arranged by appointment. If you would like a free, no-obligation review of your Social Security disability claim, please use the form below to tell me about your situation.Asterisks(*) indicate required fields.

Social Security Disability Monthly Wage Information

If your earnings are close to the substantial gainful activity level (see 20 C.F.R. § 404.1574), documentation from your employer may be essential to show the Social Security disability examiner that you are not actually performing substantial gainful activity. Your W-2 form may work fine for last year, especially if there is no question concerning the dates you worked. If there is a question about the dates worked last year, you may need information from your employer.

If you are working in the current year and a recent paystub does not show all necessary information, you may need earnings information from the employer. This form will gather it. You can also download and print the full PDF version of the Social Security Disability Monthly Wage Information Form.

Note that this form asks about vacation and sick pay. According to POMS DI 10505.010 C, only earnings paid as a result of actual work activity count. Thus, sick pay and vacation pay do not count for determining eligibility for Social Security disability benefits, although according to POMS DI 10505.010 D, bonuses do count.

To: ______________________________________________________

Re: ______________________________________________________

SSN: _____________________________________________________

Please show monthly gross income and income from vacation or sick pay for the months and years indicated:

SSD monthly wage information

Date: ________________________________
Signature: ________________________________

Title: ________________________________
Print Name: ________________________________

Continue to the full PDF version of the Social Security Disability Monthly Wage Information Form.

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